The Checklist Manifesto

Review

An insightful look at how checklists are used across industries like medicine (particularly surgery), construction, and aviation. The anecdotal stories were compelling, along with the data of how checklists improved surgery outcomes. There were some insights I had not heard before, denoting the difference between checklists for not forgetting simple steps and checklists for managing communication to solve complex issues. The idea of systematizing approaches to handling complex issues was interesting.

Highlights

The researchers found that simply having the doctors and nurses in the ICU create their own checklists for what they thought should be done each day improved the consistency of care to the point that the average length of patient stay in intensive care dropped by half.

Checklists, he found, established a higher standard of baseline performance.

Man is fallible, but maybe men are less so.

They trust instead in one set of checklists to make sure that simple steps are not missed or skipped and in another set to make sure that everyone talks through and resolves all the hard and unexpected problems.

1. Checklist for simple steps
2. Checklist for communication to resolve complexity

the real lesson is that under conditions of true complexity— where the knowledge required exceeds that of any individual and unpredictability reigns— efforts to dictate every step from the center will fail. People need room to act and adapt. Yet they cannot succeed as isolated individuals, either— that is anarchy. Instead, they require a seemingly contradictory mix of freedom and expectation— expectation to coordinate, for example, and also to measure progress toward common goals.

Overall, in this group of nearly 4,000 patients, 435 would have been expected to develop serious complications based on our earlier observation data. But instead just 277 did. Using the checklist had spared more than 150 people from harm— and 27 of them from death.

The checklist doesn’t tell him what to do, he explained. It is not a formula. But the checklist helps him be as smart as possible every step of the way, ensuring that he’s got the critical information he needs when he needs it, that he’s systematic about decision making, that he’s talked to everyone he should.